Individual
DR. GREGORY RICHMOND MANCIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA-D, LBA
Contact information
Practice address
730 FAIRVIEW AVENUE SUITE B-5, BOWLING GREEN, KY 42101
(270) 904-5071
(270) 904-5072
Mailing address
670 WAKEFIELD ST, BOWLING GREEN, KY 42103-1551
(502) 298-6983
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
KY-0017
KY
Other
Enumeration date
09/03/2011
Last updated
07/16/2012
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